Montana Healthcare Programs Provider Enrollment
(posted 04/06/2020)
Thank you for your interest in becoming a Montana Healthcare Programs provider.
Prior to enrolling, please note the following important information:
Montana Healthcare Programs Enrollment Requirements For Businesses Buying/Selling an NPI, NCPDP, and/or Changing Ownership
Any change in business ownership may require updated ownership and tax information prior to being active as a Montana Healthcare provider. Please contact Provider Relations (800) 624-3958 or email: MTenrollment@conduent.com 60 days prior to the active date.
The intent is to protect Montana providers from claim denials or duplicate submissions. There may also be critical tax implications if claims are paid to the incorrect provider. The following general guidelines are here to help you navigate through the enrollment process.
Purchasing NPI - If your business is purchasing an active NPI enrolled with Montana Healthcare Programs
- A new application will be required if tax ID information is changing.
- Claims cannot be processed until the enrollment is complete.
- All information on the National Plan & Provider Enumeration System (NPPES) will need to be updated prior to enrollment application submission. This information can be accessed at https://nppes.cms.hhs.gov/#/.
- Some provider types require state approvals including mandatory site visits which will add to the processing time.
Selling NPI - If you are selling your NPI to either an active or inactive Montana Healthcare Programs Provider
- Notify Provider Relations in writing 30 days prior to the date of the sale.
- After the sale is complete, claims submissions must not be submitted with the old provider information.
- Please contact Provider Relations (800) 624-3958 email: MTenrollment@conduent.com to help facilitate the transition.
Pharmacy Specific Requirements - Pharmacy business changes can be critical due to the high-volume nature of pharmacy claims. The following should be updated prior to enrolling.
- NCPDP number needs to be current. If purchasing a NCPDP number, the purchase agreement documentation will need to be made available to Provider Relations.
- DEA number needs to be updated.
Changing ownership - Transition between Individual and Organization owners
- The same rules apply if transitioning between individuals and organizational ownership. Because tax information is changing, a new application will need to be submitted.
- Please contact Provider Relations to help facilitate the change.
Montana Healthcare Programs enrolls providers who may be “Pay-to/Billing”, “Rendering”, and “Ordering, Referring and Prescribing (ORP)”.
Depending on your desired role, providers will select the Full, Rendering Only, or the Abbreviated Enrollment through the Montana Access to Health Web Portal. Montana Provider Relations encourages a Group/Clinic as the Pay-To with an individual Rendering billing set up when appropriate. Claims processing will depend on your enrollment type.
Providers are encouraged to enroll using the online application which will streamline the enrollment process.
Effective February 26, 2018 a provider enrollment application will be available for Rendering Only Providers. If your NPI will be listed in a Rendering, Attending, or Treating field on a claim, and you will NOT be listed as the Pay To Provider, this is the application you will use. Both an online version (preferred) and paper enrollment will be available.
Three types of provider enrollment applications will now be available:
- Full Enrollment: Provider will bill Montana Healthcare Programs directly for the services provided using the NPI/Assigned Provider ID in the Pay-To/Billing field of a claim. Appropriate for all Facilities and Group/Clinics. Appropriate for some Individual Provider Types.
- Rendering Only Enrollment: An Individual Provider is performing the service being submitted on the claim (Rendering, Attending, or Treating) but is not billing directly. Will not receive payment directly from Montana Healthcare Programs. Application is appropriate for the following Individual Provider Types.
- Audiologist
- Board Certified Behavior Analyst
- Chiropractor
- Dental
- Denturist
- Licensed Addiction Counselor
- Licensed Professional Counselor
- Nurse Midwife
- Nurse Practitioner
- Nutritionist / Dietician
- Occupational Therapist
- Optometrist
- Clinical Pharmacist
- Physical Therapist
- Physician
- Physician Assistant
- Podiatrist
- Psychiatrist
- Psychologist
- Registered Nurse Anesthetist
- Social Worker
- Speech Pathologist
3. Abbreviated Enrollment (OPR): An Individual Provider is ordering, referring or prescribing the service only. Will never directly provide services to a Montana Healthcare Programs Member. Application is appropriate for the following Individual Provider Types
- Physical Therapist
- Physician
- Physician Assistant
- Podiatrist
- Psychiatrist
- Optometrist
- Occupational Therapist
- Nurse Practitioner
- Nurse Midwife
- Dental
- Audiologist
If you have further questions about the appropriate enrollment application for you, contact:
Montana Provider Relations
Provider Enrollment
MTenrollment@conduent.com
P.O. Box 4936
Helena, MT 59604
(800) 624-3958
(406) 442.-1837 (Helena/Local)